Healthcare Provider Details

I. General information

NPI: 1699178285
Provider Name (Legal Business Name): HUI JUE WU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY WU

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 S DE ANZA BLVD SUITE D-4
CUPERTINO CA
95014-3018
US

IV. Provider business mailing address

1219 TAYLOR ST APT A
SAN FRANCISCO CA
94108-1438
US

V. Phone/Fax

Practice location:
  • Phone: 610-653-0086
  • Fax:
Mailing address:
  • Phone: 610-653-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: